|
NONPHYSICIAN TELEPHONE ASSESSMENT 5-10 M
|
Facility
IP
|
$49.00
|
|
|
Service Code
|
CPT 98966
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: AETNA Commercial |
$46.55
|
| Rate for Payer: AETNA Medicare |
$44.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$46.55
|
| Rate for Payer: BCBS Healthlink |
$44.10
|
| Rate for Payer: BCBS HMK CHIP |
$44.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$44.10
|
| Rate for Payer: BCBS POS |
$46.55
|
| Rate for Payer: BCBS Traditional |
$49.00
|
| Rate for Payer: CASH_PRICE |
$39.20
|
| Rate for Payer: CIGNA Commercial |
$46.55
|
| Rate for Payer: CIGNA Medicare |
$44.10
|
| Rate for Payer: HUMANA Commercial |
$44.10
|
| Rate for Payer: MEDICAID Medicaid |
$45.08
|
| Rate for Payer: MEDICARE Medicare |
$34.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$46.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$47.53
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$46.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$46.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$41.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$39.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$39.20
|
|
|
NONPHYSICIAN TELEPHONE ASSESSMENT 5-10 M
|
Facility
OP
|
$49.00
|
|
|
Service Code
|
CPT 98966
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: AETNA Commercial |
$46.55
|
| Rate for Payer: AETNA Medicare |
$44.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$46.55
|
| Rate for Payer: BCBS Healthlink |
$44.10
|
| Rate for Payer: BCBS HMK CHIP |
$44.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$44.10
|
| Rate for Payer: BCBS POS |
$46.55
|
| Rate for Payer: BCBS Traditional |
$49.00
|
| Rate for Payer: CASH_PRICE |
$39.20
|
| Rate for Payer: CIGNA Commercial |
$46.55
|
| Rate for Payer: CIGNA Medicare |
$44.10
|
| Rate for Payer: HUMANA Commercial |
$44.10
|
| Rate for Payer: MEDICAID Medicaid |
$45.08
|
| Rate for Payer: MEDICARE Medicare |
$34.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$46.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$47.53
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$46.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$46.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$41.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$39.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$39.20
|
|
|
NOREPINEPHRINE 1MG/ML 4ML VIAL
|
Facility
OP
|
$73.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: AETNA Commercial |
$69.35
|
| Rate for Payer: AETNA Medicare |
$65.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$69.35
|
| Rate for Payer: BCBS Healthlink |
$65.70
|
| Rate for Payer: BCBS HMK CHIP |
$65.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$65.70
|
| Rate for Payer: BCBS POS |
$69.35
|
| Rate for Payer: BCBS Traditional |
$73.00
|
| Rate for Payer: CASH_PRICE |
$58.40
|
| Rate for Payer: CIGNA Commercial |
$69.35
|
| Rate for Payer: CIGNA Medicare |
$65.70
|
| Rate for Payer: HUMANA Commercial |
$65.70
|
| Rate for Payer: MEDICAID Medicaid |
$67.16
|
| Rate for Payer: MEDICARE Medicare |
$51.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$69.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$70.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$69.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$69.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$62.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$58.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$58.40
|
|
|
NOREPINEPHRINE 1MG/ML 4ML VIAL
|
Facility
IP
|
$73.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.10 |
| Max. Negotiated Rate |
$73.00 |
| Rate for Payer: AETNA Commercial |
$69.35
|
| Rate for Payer: AETNA Medicare |
$65.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$69.35
|
| Rate for Payer: BCBS Healthlink |
$65.70
|
| Rate for Payer: BCBS HMK CHIP |
$65.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$65.70
|
| Rate for Payer: BCBS POS |
$69.35
|
| Rate for Payer: BCBS Traditional |
$73.00
|
| Rate for Payer: CASH_PRICE |
$58.40
|
| Rate for Payer: CIGNA Commercial |
$69.35
|
| Rate for Payer: CIGNA Medicare |
$65.70
|
| Rate for Payer: HUMANA Commercial |
$65.70
|
| Rate for Payer: MEDICAID Medicaid |
$67.16
|
| Rate for Payer: MEDICARE Medicare |
$51.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$69.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$70.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$69.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$69.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$62.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$58.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$58.40
|
|
|
NOROVIRUS DETECTION, RT-PCR (138307)
|
Facility
OP
|
$473.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$331.10 |
| Max. Negotiated Rate |
$473.00 |
| Rate for Payer: AETNA Commercial |
$449.35
|
| Rate for Payer: AETNA Medicare |
$425.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$449.35
|
| Rate for Payer: BCBS Healthlink |
$425.70
|
| Rate for Payer: BCBS HMK CHIP |
$425.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$425.70
|
| Rate for Payer: BCBS POS |
$449.35
|
| Rate for Payer: BCBS Traditional |
$473.00
|
| Rate for Payer: CASH_PRICE |
$378.40
|
| Rate for Payer: CIGNA Commercial |
$449.35
|
| Rate for Payer: CIGNA Medicare |
$425.70
|
| Rate for Payer: HUMANA Commercial |
$425.70
|
| Rate for Payer: MEDICAID Medicaid |
$435.16
|
| Rate for Payer: MEDICARE Medicare |
$331.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$449.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$458.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$449.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$449.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$402.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$378.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$378.40
|
|
|
NOROVIRUS DETECTION, RT-PCR (138307)
|
Facility
IP
|
$473.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$331.10 |
| Max. Negotiated Rate |
$473.00 |
| Rate for Payer: AETNA Commercial |
$449.35
|
| Rate for Payer: AETNA Medicare |
$425.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$449.35
|
| Rate for Payer: BCBS Healthlink |
$425.70
|
| Rate for Payer: BCBS HMK CHIP |
$425.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$425.70
|
| Rate for Payer: BCBS POS |
$449.35
|
| Rate for Payer: BCBS Traditional |
$473.00
|
| Rate for Payer: CASH_PRICE |
$378.40
|
| Rate for Payer: CIGNA Commercial |
$449.35
|
| Rate for Payer: CIGNA Medicare |
$425.70
|
| Rate for Payer: HUMANA Commercial |
$425.70
|
| Rate for Payer: MEDICAID Medicaid |
$435.16
|
| Rate for Payer: MEDICARE Medicare |
$331.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$449.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$458.81
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$449.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$449.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$402.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$378.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$378.40
|
|
|
NORTRIPYLINE 10 MG TAB- NF
|
Facility
OP
|
$8.00
|
|
| Hospital Charge Code |
20230420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
NORTRIPYLINE 10 MG TAB- NF
|
Facility
IP
|
$8.00
|
|
| Hospital Charge Code |
20230420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
NOVOLOG 100U/1ML INJECTION 10ML VIAL
|
Facility
OP
|
$693.00
|
|
|
Service Code
|
CPT J1817
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$485.10 |
| Max. Negotiated Rate |
$693.00 |
| Rate for Payer: AETNA Commercial |
$658.35
|
| Rate for Payer: AETNA Medicare |
$623.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$658.35
|
| Rate for Payer: BCBS Healthlink |
$623.70
|
| Rate for Payer: BCBS HMK CHIP |
$623.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$623.70
|
| Rate for Payer: BCBS POS |
$658.35
|
| Rate for Payer: BCBS Traditional |
$693.00
|
| Rate for Payer: CASH_PRICE |
$554.40
|
| Rate for Payer: CIGNA Commercial |
$658.35
|
| Rate for Payer: CIGNA Medicare |
$623.70
|
| Rate for Payer: HUMANA Commercial |
$623.70
|
| Rate for Payer: MEDICAID Medicaid |
$637.56
|
| Rate for Payer: MEDICARE Medicare |
$485.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$658.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$672.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$658.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$658.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$589.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$554.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$554.40
|
|
|
NOVOLOG 100U/1ML INJECTION 10ML VIAL
|
Facility
IP
|
$693.00
|
|
|
Service Code
|
CPT J1817
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$485.10 |
| Max. Negotiated Rate |
$693.00 |
| Rate for Payer: AETNA Commercial |
$658.35
|
| Rate for Payer: AETNA Medicare |
$623.70
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$658.35
|
| Rate for Payer: BCBS Healthlink |
$623.70
|
| Rate for Payer: BCBS HMK CHIP |
$623.70
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$623.70
|
| Rate for Payer: BCBS POS |
$658.35
|
| Rate for Payer: BCBS Traditional |
$693.00
|
| Rate for Payer: CASH_PRICE |
$554.40
|
| Rate for Payer: CIGNA Commercial |
$658.35
|
| Rate for Payer: CIGNA Medicare |
$623.70
|
| Rate for Payer: HUMANA Commercial |
$623.70
|
| Rate for Payer: MEDICAID Medicaid |
$637.56
|
| Rate for Payer: MEDICARE Medicare |
$485.10
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$658.35
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$672.21
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$658.35
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$658.35
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$589.05
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$554.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$554.40
|
|
|
NP THYROID 60MG TABLET-NF
|
Facility
OP
|
$8.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
NP THYROID 60MG TABLET-NF
|
Facility
IP
|
$8.00
|
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: AETNA Commercial |
$7.60
|
| Rate for Payer: AETNA Medicare |
$7.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$7.60
|
| Rate for Payer: BCBS Healthlink |
$7.20
|
| Rate for Payer: BCBS HMK CHIP |
$7.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$7.20
|
| Rate for Payer: BCBS POS |
$7.60
|
| Rate for Payer: BCBS Traditional |
$8.00
|
| Rate for Payer: CASH_PRICE |
$6.40
|
| Rate for Payer: CIGNA Commercial |
$7.60
|
| Rate for Payer: CIGNA Medicare |
$7.20
|
| Rate for Payer: HUMANA Commercial |
$7.20
|
| Rate for Payer: MEDICAID Medicaid |
$7.36
|
| Rate for Payer: MEDICARE Medicare |
$5.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$7.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$7.76
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$7.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$7.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$6.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$6.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$6.40
|
|
|
NS 100mL Charge only
|
Facility
IP
|
$9.00
|
|
|
Service Code
|
CPT J7050
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: AETNA Commercial |
$8.55
|
| Rate for Payer: AETNA Medicare |
$8.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$8.55
|
| Rate for Payer: BCBS Healthlink |
$8.10
|
| Rate for Payer: BCBS HMK CHIP |
$8.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$8.10
|
| Rate for Payer: BCBS POS |
$8.55
|
| Rate for Payer: BCBS Traditional |
$9.00
|
| Rate for Payer: CASH_PRICE |
$7.20
|
| Rate for Payer: CIGNA Commercial |
$8.55
|
| Rate for Payer: CIGNA Medicare |
$8.10
|
| Rate for Payer: HUMANA Commercial |
$8.10
|
| Rate for Payer: MEDICAID Medicaid |
$8.28
|
| Rate for Payer: MEDICARE Medicare |
$6.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$8.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$8.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$8.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$8.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$7.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$7.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$7.20
|
|
|
NS 100mL Charge only
|
Facility
OP
|
$9.00
|
|
|
Service Code
|
CPT J7050
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: AETNA Commercial |
$8.55
|
| Rate for Payer: AETNA Medicare |
$8.10
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$8.55
|
| Rate for Payer: BCBS Healthlink |
$8.10
|
| Rate for Payer: BCBS HMK CHIP |
$8.10
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$8.10
|
| Rate for Payer: BCBS POS |
$8.55
|
| Rate for Payer: BCBS Traditional |
$9.00
|
| Rate for Payer: CASH_PRICE |
$7.20
|
| Rate for Payer: CIGNA Commercial |
$8.55
|
| Rate for Payer: CIGNA Medicare |
$8.10
|
| Rate for Payer: HUMANA Commercial |
$8.10
|
| Rate for Payer: MEDICAID Medicaid |
$8.28
|
| Rate for Payer: MEDICARE Medicare |
$6.30
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$8.55
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$8.73
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$8.55
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$8.55
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$7.65
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$7.20
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$7.20
|
|
|
NT-PROBNP (143000)
|
Facility
OP
|
$341.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$238.70 |
| Max. Negotiated Rate |
$341.00 |
| Rate for Payer: AETNA Commercial |
$323.95
|
| Rate for Payer: AETNA Medicare |
$306.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$323.95
|
| Rate for Payer: BCBS Healthlink |
$306.90
|
| Rate for Payer: BCBS HMK CHIP |
$306.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$306.90
|
| Rate for Payer: BCBS POS |
$323.95
|
| Rate for Payer: BCBS Traditional |
$341.00
|
| Rate for Payer: CASH_PRICE |
$272.80
|
| Rate for Payer: CIGNA Commercial |
$323.95
|
| Rate for Payer: CIGNA Medicare |
$306.90
|
| Rate for Payer: HUMANA Commercial |
$306.90
|
| Rate for Payer: MEDICAID Medicaid |
$313.72
|
| Rate for Payer: MEDICARE Medicare |
$238.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$323.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$330.77
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$323.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$323.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$289.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$272.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$272.80
|
|
|
NT-PROBNP (143000)
|
Facility
IP
|
$341.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$238.70 |
| Max. Negotiated Rate |
$341.00 |
| Rate for Payer: AETNA Commercial |
$323.95
|
| Rate for Payer: AETNA Medicare |
$306.90
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$323.95
|
| Rate for Payer: BCBS Healthlink |
$306.90
|
| Rate for Payer: BCBS HMK CHIP |
$306.90
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$306.90
|
| Rate for Payer: BCBS POS |
$323.95
|
| Rate for Payer: BCBS Traditional |
$341.00
|
| Rate for Payer: CASH_PRICE |
$272.80
|
| Rate for Payer: CIGNA Commercial |
$323.95
|
| Rate for Payer: CIGNA Medicare |
$306.90
|
| Rate for Payer: HUMANA Commercial |
$306.90
|
| Rate for Payer: MEDICAID Medicaid |
$313.72
|
| Rate for Payer: MEDICARE Medicare |
$238.70
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$323.95
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$330.77
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$323.95
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$323.95
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$289.85
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$272.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$272.80
|
|
|
NYSTATIN POWDER [100 MU/GM]
|
Facility
IP
|
$172.25
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20230803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$120.57 |
| Max. Negotiated Rate |
$172.25 |
| Rate for Payer: AETNA Commercial |
$163.64
|
| Rate for Payer: AETNA Medicare |
$155.03
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$163.64
|
| Rate for Payer: BCBS Healthlink |
$155.03
|
| Rate for Payer: BCBS HMK CHIP |
$155.03
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$155.03
|
| Rate for Payer: BCBS POS |
$163.64
|
| Rate for Payer: BCBS Traditional |
$172.25
|
| Rate for Payer: CASH_PRICE |
$137.80
|
| Rate for Payer: CIGNA Commercial |
$163.64
|
| Rate for Payer: CIGNA Medicare |
$155.03
|
| Rate for Payer: HUMANA Commercial |
$155.03
|
| Rate for Payer: MEDICAID Medicaid |
$158.47
|
| Rate for Payer: MEDICARE Medicare |
$120.57
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$163.64
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$167.08
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$163.64
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$163.64
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$146.41
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$137.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$137.80
|
|
|
NYSTATIN POWDER [100 MU/GM]
|
Facility
OP
|
$172.25
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20230803
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$120.57 |
| Max. Negotiated Rate |
$172.25 |
| Rate for Payer: AETNA Commercial |
$163.64
|
| Rate for Payer: AETNA Medicare |
$155.03
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$163.64
|
| Rate for Payer: BCBS Healthlink |
$155.03
|
| Rate for Payer: BCBS HMK CHIP |
$155.03
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$155.03
|
| Rate for Payer: BCBS POS |
$163.64
|
| Rate for Payer: BCBS Traditional |
$172.25
|
| Rate for Payer: CASH_PRICE |
$137.80
|
| Rate for Payer: CIGNA Commercial |
$163.64
|
| Rate for Payer: CIGNA Medicare |
$155.03
|
| Rate for Payer: HUMANA Commercial |
$155.03
|
| Rate for Payer: MEDICAID Medicaid |
$158.47
|
| Rate for Payer: MEDICARE Medicare |
$120.57
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$163.64
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$167.08
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$163.64
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$163.64
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$146.41
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$137.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$137.80
|
|
|
NYSTATIN SUSP [100,000 U/ML] 60 ML BTL
|
Facility
IP
|
$48.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: AETNA Commercial |
$45.60
|
| Rate for Payer: AETNA Medicare |
$43.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$45.60
|
| Rate for Payer: BCBS Healthlink |
$43.20
|
| Rate for Payer: BCBS HMK CHIP |
$43.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$43.20
|
| Rate for Payer: BCBS POS |
$45.60
|
| Rate for Payer: BCBS Traditional |
$48.00
|
| Rate for Payer: CASH_PRICE |
$38.40
|
| Rate for Payer: CIGNA Commercial |
$45.60
|
| Rate for Payer: CIGNA Medicare |
$43.20
|
| Rate for Payer: HUMANA Commercial |
$43.20
|
| Rate for Payer: MEDICAID Medicaid |
$44.16
|
| Rate for Payer: MEDICARE Medicare |
$33.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$45.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$46.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$45.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$45.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$40.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$38.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$38.40
|
|
|
NYSTATIN SUSP [100,000 U/ML] 60 ML BTL
|
Facility
OP
|
$48.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: AETNA Commercial |
$45.60
|
| Rate for Payer: AETNA Medicare |
$43.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$45.60
|
| Rate for Payer: BCBS Healthlink |
$43.20
|
| Rate for Payer: BCBS HMK CHIP |
$43.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$43.20
|
| Rate for Payer: BCBS POS |
$45.60
|
| Rate for Payer: BCBS Traditional |
$48.00
|
| Rate for Payer: CASH_PRICE |
$38.40
|
| Rate for Payer: CIGNA Commercial |
$45.60
|
| Rate for Payer: CIGNA Medicare |
$43.20
|
| Rate for Payer: HUMANA Commercial |
$43.20
|
| Rate for Payer: MEDICAID Medicaid |
$44.16
|
| Rate for Payer: MEDICARE Medicare |
$33.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$45.60
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$46.56
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$45.60
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$45.60
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$40.80
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$38.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$38.40
|
|
|
NYSTATIN-TRIAMCINOLONE CRM [15 GM]
|
Facility
IP
|
$376.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$263.20 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: AETNA Commercial |
$357.20
|
| Rate for Payer: AETNA Medicare |
$338.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$357.20
|
| Rate for Payer: BCBS Healthlink |
$338.40
|
| Rate for Payer: BCBS HMK CHIP |
$338.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$338.40
|
| Rate for Payer: BCBS POS |
$357.20
|
| Rate for Payer: BCBS Traditional |
$376.00
|
| Rate for Payer: CASH_PRICE |
$300.80
|
| Rate for Payer: CIGNA Commercial |
$357.20
|
| Rate for Payer: CIGNA Medicare |
$338.40
|
| Rate for Payer: HUMANA Commercial |
$338.40
|
| Rate for Payer: MEDICAID Medicaid |
$345.92
|
| Rate for Payer: MEDICARE Medicare |
$263.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$357.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$364.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$357.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$357.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$319.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$300.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$300.80
|
|
|
NYSTATIN-TRIAMCINOLONE CRM [15 GM]
|
Facility
OP
|
$376.00
|
|
|
Service Code
|
CPT J3490
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$263.20 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: AETNA Commercial |
$357.20
|
| Rate for Payer: AETNA Medicare |
$338.40
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$357.20
|
| Rate for Payer: BCBS Healthlink |
$338.40
|
| Rate for Payer: BCBS HMK CHIP |
$338.40
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$338.40
|
| Rate for Payer: BCBS POS |
$357.20
|
| Rate for Payer: BCBS Traditional |
$376.00
|
| Rate for Payer: CASH_PRICE |
$300.80
|
| Rate for Payer: CIGNA Commercial |
$357.20
|
| Rate for Payer: CIGNA Medicare |
$338.40
|
| Rate for Payer: HUMANA Commercial |
$338.40
|
| Rate for Payer: MEDICAID Medicaid |
$345.92
|
| Rate for Payer: MEDICARE Medicare |
$263.20
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$357.20
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$364.72
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$357.20
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$357.20
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$319.60
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$300.80
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$300.80
|
|
|
OBSV CARE SAME DAY HIGH COMPLEX 99236
|
Facility
OP
|
$457.00
|
|
|
Service Code
|
CPT 99236
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$319.90 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: AETNA Commercial |
$434.15
|
| Rate for Payer: AETNA Medicare |
$411.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$434.15
|
| Rate for Payer: BCBS Healthlink |
$411.30
|
| Rate for Payer: BCBS HMK CHIP |
$411.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$411.30
|
| Rate for Payer: BCBS POS |
$434.15
|
| Rate for Payer: BCBS Traditional |
$457.00
|
| Rate for Payer: CASH_PRICE |
$365.60
|
| Rate for Payer: CIGNA Commercial |
$434.15
|
| Rate for Payer: CIGNA Medicare |
$411.30
|
| Rate for Payer: HUMANA Commercial |
$411.30
|
| Rate for Payer: MEDICAID Medicaid |
$420.44
|
| Rate for Payer: MEDICARE Medicare |
$319.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$434.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$443.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$434.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$434.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$388.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$365.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$365.60
|
|
|
OBSV CARE SAME DAY HIGH COMPLEX 99236
|
Facility
IP
|
$457.00
|
|
|
Service Code
|
CPT 99236
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$319.90 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: AETNA Commercial |
$434.15
|
| Rate for Payer: AETNA Medicare |
$411.30
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$434.15
|
| Rate for Payer: BCBS Healthlink |
$411.30
|
| Rate for Payer: BCBS HMK CHIP |
$411.30
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$411.30
|
| Rate for Payer: BCBS POS |
$434.15
|
| Rate for Payer: BCBS Traditional |
$457.00
|
| Rate for Payer: CASH_PRICE |
$365.60
|
| Rate for Payer: CIGNA Commercial |
$434.15
|
| Rate for Payer: CIGNA Medicare |
$411.30
|
| Rate for Payer: HUMANA Commercial |
$411.30
|
| Rate for Payer: MEDICAID Medicaid |
$420.44
|
| Rate for Payer: MEDICARE Medicare |
$319.90
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$434.15
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$443.29
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$434.15
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$434.15
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$388.45
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$365.60
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$365.60
|
|
|
OBSV CARE SAME DAY LOW COMPLEX 99234
|
Facility
IP
|
$278.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
20221105
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$194.60 |
| Max. Negotiated Rate |
$278.00 |
| Rate for Payer: AETNA Commercial |
$264.10
|
| Rate for Payer: AETNA Medicare |
$250.20
|
| Rate for Payer: BCBS CLOSED PLAN NETWORK |
$264.10
|
| Rate for Payer: BCBS Healthlink |
$250.20
|
| Rate for Payer: BCBS HMK CHIP |
$250.20
|
| Rate for Payer: BCBS MCR ADVANTAGE Medicare Part A |
$250.20
|
| Rate for Payer: BCBS POS |
$264.10
|
| Rate for Payer: BCBS Traditional |
$278.00
|
| Rate for Payer: CASH_PRICE |
$222.40
|
| Rate for Payer: CIGNA Commercial |
$264.10
|
| Rate for Payer: CIGNA Medicare |
$250.20
|
| Rate for Payer: HUMANA Commercial |
$250.20
|
| Rate for Payer: MEDICAID Medicaid |
$255.76
|
| Rate for Payer: MEDICARE Medicare |
$194.60
|
| Rate for Payer: MONIDA - ALLEGIANCE Commercial |
$264.10
|
| Rate for Payer: MONIDA - FIRST CHOICE HEALTH Commercial |
$269.66
|
| Rate for Payer: MONIDA - MONTANA HEALTH COOP Commercial |
$264.10
|
| Rate for Payer: MONIDA - PACIFICSOURCE Commercial |
$264.10
|
| Rate for Payer: UNITED HEALTHCARE Commercial |
$236.30
|
| Rate for Payer: UNITED HEALTHCARE MCD ADVANTAGE Medicaid |
$222.40
|
| Rate for Payer: UNITED HEALTHCARE MCR ADVANTAGE RHC Medicare |
$222.40
|
|
